Emergency Physicians' Perceived Influence of EHR Use on Clinical Workflow and Performance Metrics

OBJECTIVE Over the last decade, electronic health records (EHRs) have shaped clinical practice. In this article, we investigated the perceived effects of EHR use on clinical workflow and meaningful use (MU) performance metrics. MATERIALS AND METHODS Semistructured interviews were conducted with 20 (n = 20) physicians at two urban emergency departments. Interview questions focused on time spent on EHR use, changes in clinical practices with EHR use, and the effect of MU performance metrics on clinical workflow. Qualitative coding using grounded theory and descriptive analyses were performed to provide descriptive insights. RESULTS Physicians reported that EHRs improved their clinical workflow, especially on MU-related activities including door-to-doctor time and admit decision time. EHR use also affected physicians work efficiency, quality of care provided, and overall patient safety. CONCLUSION Physicians' perception of EHRs is likely to influence their practices. With negative perceptions of EHR usability problems, positive aspects of EHR use, including the influence on MU performance metrics, may be overridden.

[1]  D. Blumenthal,et al.  The benefits of health information technology: a review of the recent literature shows predominantly positive results. , 2011, Health affairs.

[2]  Fiona M. Callaghan,et al.  Use of internist's free time by ambulatory care Electronic Medical Record systems. , 2014, JAMA internal medicine.

[3]  T. Savides,et al.  The Impact of Physician EHR Usage on Patient Satisfaction , 2018, Applied Clinical Informatics.

[4]  Lena Mamykina,et al.  Clinical documentation: composition or synthesis? , 2012, J. Am. Medical Informatics Assoc..

[5]  I. Stiell,et al.  Assessment of the impact on time to complete medical record using an electronic medical record versus a paper record on emergency department patients: a study , 2013, Emergency Medicine Journal.

[6]  C. Chisholm,et al.  A task analysis of emergency physician activities in academic and community settings. , 2011, Annals of emergency medicine.

[7]  Peter Hoonakker,et al.  Impact of electronic health record technology on the work and workflow of physicians in the intensive care unit , 2015, Int. J. Medical Informatics.

[8]  Stuart R Lipsitz,et al.  Physician Beliefs about the Meaningful Use of the Electronic Health Record: A Follow-Up Study , 2017, Appl. Clin. Inform..

[9]  C. Pozner,et al.  Emergency Medicine Resident Physicians’ Perceptions of Electronic Documentation and Workflow , 2015, Applied Clinical Informatics.

[10]  D. Handel,et al.  Implementing electronic health records in the emergency department. , 2010, The Journal of emergency medicine.

[11]  D. Bates,et al.  Finding the meaning in meaningful use. , 2011, The New England journal of medicine.

[12]  Charlotte A. Weaver,et al.  Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. , 2013, Journal of the American Medical Informatics Association : JAMIA.

[13]  Vimla L. Patel,et al.  Contextual Computing: A Bluetooth based approach for tracking healthcare providers in the emergency room , 2017, J. Biomed. Informatics.

[14]  Soroush Saghafian,et al.  Physician in Triage Versus Rotational Patient Assignment. , 2016, The Journal of emergency medicine.

[15]  Pamela Jordan.  Basics of qualitative research: Grounded theory procedures and techniques , 1994 .

[16]  Joi L. Moore,et al.  Addressing Human Computer Interaction Issues of Electronic Health Record in Clinical Encounters , 2013, HCI.

[17]  Christine A. Sinsky,et al.  Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties , 2016, Annals of Internal Medicine.

[18]  Robert G Hill,et al.  4000 clicks: a productivity analysis of electronic medical records in a community hospital ED. , 2013, The American journal of emergency medicine.

[19]  Adam Wright,et al.  Meaningful use and quality of care. , 2014, JAMA internal medicine.

[20]  M. Harris,et al.  Resuscitate ED metrics with split-flow design. , 2012, Healthcare financial management : journal of the Healthcare Financial Management Association.

[21]  M. Furukawa,et al.  Physician attitudes on ease of use of EHR functionalities related to Meaningful Use. , 2015, The American journal of managed care.

[22]  Jason S Shapiro,et al.  Efficiency of Emergency Physicians: Insights from an Observational Study using EHR Log Files , 2018, Applied Clinical Informatics.

[23]  Karin V Rhodes,et al.  A conceptual model of emergency department crowding. , 2003, Annals of emergency medicine.

[24]  Sun Young Park,et al.  The effects of EMR deployment on doctors' work practices: A qualitative study in the emergency department of a teaching hospital , 2012, Int. J. Medical Informatics.

[25]  Tosha B. Wetterneck,et al.  Meaningful use’s benefits and burdens for US family physicians , 2018, J. Am. Medical Informatics Assoc..